{include file="header.tpl"}

<div class="page_body">

<div class="page_register">

<form name= "registreren" action="{$smarty.const.DOMAIN_URL}/register/newRegistration/{$firstquestion}" method="post">
Uw gebruikersnaam.<br />
<input size="60" type="text" name="username" tabindex="1" value="{$username}"></input>
<br /><br />
Uw echte naam.<br />
<input size="60" type="text" name="realname" tabindex="2" value="{$realname}"></input>
<br /><br />
Uw e-mail adres.<br />
<input id="email" size="60" type="text" name="emailaddress" tabindex="3" value="{$email}"></input>
<br /><br />
Uw geboortedatum.<br />
<input size="30" type="text" name="birthdate"  tabindex="4" value="invoeren als jaar\maand\dag"></input>
<br /><br />
Uw wachtwoord.<br />
<input size="30" type="password" name="password_1" tabindex="5"></input>
<br /><br />
Herhaal uw wachtwoord.<br />
<input size="30" type="password" name="password_2" tabindex="6"></input>
<br /><br />
<input TYPE="hidden" VALUE="{$firstquestion}" NAME="firstquestion">
<input name="button" value="Registreer mij." type="submit" tabindex="7" />
<br /><br />
</form>
Opmerking:<br />
Wachtwoord is minimaal 6 karakters, bevat minimaal 1 hoofdletter en minmaal 1 cijfer.
</div>

</div>

{include file="footer.tpl"}